Laparoscopic sacrocolpopexy: impact of the learning curve. Historic retrospective comparative study between two series of 93 and 169 patients

摘要

Genital prolapse is one of the most frequent reasons for gynaecologic consultations. Laparoscopic sacrocolpopexy (LSC) became the gold standard since laparoscopy was developed. We retrospectively compared two groups of patients: 82 who undergone LSC from January 1996 to December 2002 (group A) and 169 from January 2002 to December 2009 (group B), always by the same team. Suspension was reinforced with two strips of synthetic mesh. Laparoscopy was performed in 93 women of group A and 169 of group B. They all had symptomatic uterine prolapse. Conversion to laparotomy because of technical difficulties was significantly lower in the second than the first period (1 vs. 11, p 0.001). We performed less culdoplasty, levator myorrhaphy and Burch colposuspension (p 0.001) but more associated cure of urinary stress incontinence in the second period. Peri-operative complications (7.3% vs. 1.8%, p = 0.006), post-operative complications (21% vs. 5%), and surgical length decreased (231 to 191 min, p 0.001). Six patients (7%) in group A had re-intervention, 15 (9%) in group B. LSC is a reproducible technique. A learning curve shortens the length of intervention and operative and post-operative complications and rate of conversion to laparotomy.